TRADITIONAL, NOT CONVENTIONAL.

When Someone Is In The Hospital (November 11, 2014)

A longer version of this article was originally published by my friend Kelly Graham in the Autumn 2013 edition of UB GoodNews. She has kindly allowed me to slightly edit and re-print it here, along with my own underlinings and bullets for emphasis.

My intention was to talk about protection as it pertains to insurance, but some experiences I’ve had recently have brought me to discuss something slightly different: protection in health crisis situations.

One day this past spring my significant other, Hani, called my office and said he was headed to the emergency room because of his heart. Now, this is always a shocking call to receive, and for me it was also confusing. My sweetie is in great shape. He works in a physical job where he sweats every day, he played soccer 3 to 4 hours a day for 20 years, he eats a ridiculously healthy diet, and he is just 44 years old.

But here we were: he in a bed in the emergency room, and me sitting beside the bed waiting to find out why we were there. You see, he had no symptoms. No shortness of breath. No chest pain. Nothing. But still, we were in the ER.

The path to the emergency room was this: He had gone to his regular doctor with a bad cold. The doctor said his heart seemed to be skipping a beat and that Hani should follow up with a cardiologist. Said cardiologist fitted him with a halter monitor, and then called him 30 minutes later and said, "come to the ER." Hence our rendezvous.

And so we sat, with no symptoms, my darling in his dirty work clothes (he’s a carpenter), me in a suit with my briefcase (containing my cell phone and a bottle of water), and both quite confused.

We eventually learned that Hani had had an episode of ventricular tachycardia (V-tach) during his stress test with the cardiologist, and that the plan was to admit him to the hospital and perform an angiogram the next day, which would probably include an angioplasty to treat the expected blocked artery or arteries.

I noticed that whenever someone came in the room to talk to us, he or she would use terms I was not familiar with and talk about things of which I had no knowledge (like all the stuff in the paragraph above). So I started taking notes in the memo function of my smartphone. (I could have used a pen and paper, of course, but I didn’t have that and I did have the phone.)

Interestingly, I saw “No Cell Phone Use” signs all over the ER and the hospital, yet every single person who worked there was actively using his or her cell phone – receiving texts from the lab, emails from doctors, and calls from different departments (I asked). So bring your phone. And a charger (I now carry a wall charger in my car, along with the car charger).

I started writing down the terminology that was being used and asking for explanations. And I kept asking until I felt I understood. I wrote down things like "V-tach" and "arrhythmia" and "bigeminy" and "trigeminy".

For most of us, doctors are authority figures, and we are taught to listen to what they say. I suppose that generally that's fine. But in a very unfamiliar situation – in a life-and-death situation – I learned it can be smart to take notes, pay attention, and challenge assumptions.

It was really startling to me to find out that people in the hospital – that is, the nurses, the medical technicians, the ones who are supposed to be helping – don't always know what they're talking about.

Here's one example: we were interviewed ELEVEN separate times after Hani was admitted to the hospital. In each of those interviews, the questions were virtually the same: “What brought you to the hospital? Did you have chest pain? Did you have shortness of breath? Did you feel faint?” The answer to all, of course, was NO. “So why did you come to the hospital?” they would ask. And I would reply that the doctor requested he come to the ER because he had an episode of ventricular tachycardia.

In 8 of the 11 interviews the staff person then said, “Oh, he had a heart attack.” No, he didn't. Ventricular tachycardia is not a heart attack. It can lead to a heart attack, but V-tach in and of itself is not a heart attack.

It frightens me to know that if I had not asked all those questions about V-tach, and exactly what it is and what it means, and made notes during those conversations, I might have gone along with that wrong assessment of “heart attack.” In fact, often the technicians or nurses or “patient advocate” or whomever so vociferously insisted they were right that I would go back to my notes and read them out loud, until they, too, understood that V-tach is not a heart attack.

Why was that so important to me? Well, without the patient’s insistence that the information entered in the medical charts is correct, the person entering information in the computer will enter whatever his or her own thoughts are – and if he or she is of the opinion that V-tach is a heart attack – guess what? The next time that patient tries to get life insurance, or medical insurance, or needs to be screened for anything that requires looking at medical records (as do many jobs nowadays), those records will say he or she has had a heart attack. That can raise prices, eliminate opportunities, and – most important, in my opinion – color the perceptions of every other medical professional who sees the information. Future treatment will always be based on the “fact” that this patient had a heart attack, even though he did not.

Since this situation, I've talked to many people who told me that when they had to go to the hospital with a parent or a loved one, they were surprised to learn that the medical record contained all sorts of information that was not correct. And here's the thing: Your treatment in a medical emergency is based on what's in your medical history and what the doctor sees in front of him or her. So you want to make sure that record is correct.

So here are my suggestions:

Take notes.

Ask for explanations.

Look up information online (using a site like Mayo Clinic or Web MD).

Ask more questions. Don't stop asking questions until you are satisfied with the answers.

Make no mistake: these doctors work for you. You are the consumer. You have the right to ask questions and get answers.

Since this situation in May we have had several other experiences with hospitals: Hani has had follow-up work at three different practices; I was admitted with abdominal pain; a client had very involved and serious spinal surgery; etc. etc. etc. So now my “go to” gift for anyone entering the hospital is a spiral notebook with a pen attached to it with a ribbon, and the patient’s name written on the cover. And based on the experiences we’ve had, here are some additional recommendations:

When the doctor visits, TAKE NOTES. Use your laptop, your smartphone, a spiral notebook as described above (the best choice) – but write everything down. If you have questions, ask them, and write down the answers. Write the date and time for every entry. In fact, take notes when ANYONE visits — and write down everything. The spiral notebook is the best choice because all visitors can help with this methodology; and it’s very simple to look at the notes from the day before to check, for example, if what is happening today is what you were told would happen today.

Do your own research. It will help you understand conversations with the doctors, nurses, and medical technicians, and it will often help you understand more about what questions you should ask. I have found the Mayo Clinic website to be an excellent source. One way to avoid commercial sites and visit only research- and information-oriented sites is to enter your search term – say, "electrophysiology", in Google, then enter ".com". This will offer “hits” on electrophysiology while deleting results that are “dot com,” or commercial, results.

From my experience, I believe someone should stay with the patient 24 hours a day if it is at all possible. If a patient has had a procedure that results in severe pain, he or she likely will be incapable of understanding the doctor or nurse, asking questions or understanding the answers, or taking notes. Even if the patient is not in severe pain, a hospital is a very disorienting place and it’s rarely a good idea to leave the patient alone for long periods or overnight.

If the patient has any requests – for food, for help, for pain medication – write down the request in the notebook, including the date and time the request was made. Then write down when the request is fulfilled – particularly in the case of pain medication. The client who had spinal surgery was in very severe pain, and every time she requested pain medication, it took between 60 and 90 minutes to receive it. The patient’s family used their notes on this to have the doctor change the orders so medication could be requested more frequently and in larger doses to better manage her pain.

When people ask how they can help, or what they can bring to the hospital, don’t hesitate to tell them. Especially in an emergency situation, there are often mundane daily chores that are really quite important: watering the plants. Walking/feeding pets.

Making calls to friends/colleagues/clients. Let your friends or family bring the things you didn’t realize would be essential as you rushed out the door: eyedrops, a favorite blanket, sweetener for your coffee or tea, some current magazines, your phone charger, moisturizer, TV Guide, an emery board, a deck of cards, your tablet or laptop. You get the idea. And tell them things that are not a good idea: food, if there are dietary restrictions; flowers, if there are allergies or breathing problems.

That tablet or laptop is useful for more than just surfing to pass the time. Use it to look up the Patient’s Bill of Rights at the hospital; you may need to show it to the desk when you ask for copies of everything you’ve signed and copies of your medical records (the name of the specific record you want to request is UB04). Use it to look up information on your condition. Use it to check the background of your doctor and read any patient reviews on him or her – this can give you direction in working with the doctor. Use it to email updates to friends and family.

And if you want or need prayers, ask. In fact, that last point may be the most important point of all.

Kelly Graham is recently discovering, after more than three decades as an investment advisor in Nashville, the potential payoffs that can result from investing in one's own health. She reads dr. diane's newsletter religiously.